How Long Does CAQH Credentialing Take? Timelines and Tips for Providers  

If you are a healthcare provider who is going through the credentialing process, you might have heard of the CAQH (Council for Affordable Quality Healthcare) ProView. Its centralized database streamlines the credentialing process by providing different payers access to a standard profile that contains your credentials and other essential documents. Nonetheless, knowing the CAQH timeline is critical when planning for your practice’s credentialing.

Understanding the CAQH ProView Process 

The CAQH ProView system is a centralized credentialing information repository for providers. Instead of preparing and submitting applications to different insurance companies, insurers may access a standard application in the ProView platform. 

These are the step-by-step process to complete your CAQH profile: 

• Initial registration and profile creation
• Uploading and verification of documents 
• Profile attestation
• Authorization of access to insurers 
• Regular re-attestation (every 120 days) 

Typical CAQH Timeline Breakdown

The total time from starting your CAQH profile to having it fully accessible to insurers typically follows this timeline: 

Initial CAQH Profile Completion: 1-3 Hours

Successfully creating your CAQH profile from scratch typically takes 1-3 hours, depending on how organized your documentation is. This includes entering: 

• Personal and professional information 
• Education and training history 
• Practice locations 
• Hospital affiliations 
• Work history 
• License information 
• Professional liability coverage 

Document Upload and Processing: 1-7 Days

After completing your profile, you’ll need to upload supporting documentation such as: 

• Professional licenses 
• DEA registration 
• Malpractice insurance certificates 
• Board certifications 
• Educational diplomas 

You may upload the documents immediately, but CAQH processes and verifies these documents usually within 1-7 business days. 

Attestation Approval: 1-2 Business Days

After the profile has been completed and documentation uploaded, the user must attest to the veracity of the information. The approval is processed by CAQH within 1-2 business days.  

CAQH Profile Activation: 3-10 Business Days

After the attestation approval, achieving an active CAQH profile typically takes 3-10 business days, assuming no issues arise during activation. 

Although the profile status in the platform indicates that information is complete, it still cannot be accessed till an authorization is provided. 

Factors That Can Extend Your CAQH Timeline

Some of the common problems that may delay your CAQH processing are, but not limited to: 

Incomplete Information

Profile update delays frequently happen due to missing fields or sections in your profile. All mandatory documentation fields must be completed for CAQH to proceed to the next steps.  

Documentation Issues

Problems with uploaded documents, such as expired licenses or documents that cannot be read in the system, might delay the processing until resolved.  

Verification Discrepancies

If verification discrepancies happen in provided or unconfirmed information, or CAQH finds inconsistencies between the information on file and what is provided, they’ll flag your profile for further review. 

Holidays and System Maintenance

Processing times may take longer during holidays or periodic system upgrades when CAQH staff might be reduced.  

Obvious Differences: CAQH vs Full Credentialing

A crucial point frequently misunderstood: filling out your CAQH profile is only one step in the entire process of credentialing. Although your CAQH profile may become active within days, the complete insurance credentialing process usually takes: 

• For commercial payers: 60-120 days 
• For Medicare: 90-150 days 
• For Medicaid: 60-180 days (varies significantly from state to state) 

Your CAQH profile allows your information to be available to these entities; it doesn’t replace their respective internal credentialing processes. 

Tips for Expediting Your CAQH Process 

Follow these tips to expedite your CAQH credentialing process: 

Prepare All Documentation Before Starting

Make sure all necessary documents are collected and in digital form before you start creating your profile, so that the upload process will be quick. 

Complete All Fields

Optional fields should be completed whenever possible to avoid follow-up requests. 

Use Consistent Information

Ensure all dates, addresses, and other details match exactly across all documents and application fields. 

Check for Expired Documents

Make sure that licenses, certificates, and insurance do not expire before you upload them. 

Set Calendar Reminders for Re-attestation 

CAQH requires re-attestation every 120 days, whether or not changes have been made. Failure to meet this deadline will lead to the inactivation of your profile. 

Respond Promptly to CAQH Queries 

If contacted by CAQH with questions or further information, respond quickly to avoid further delay.  

Tracking Your CAQH Status 

There are several status indicators in the CAQH system: 

• Initial Profile: You have initiated but not completed your profile. 
• Profile Review: Their review of the information you have provided is in progress. 
• Incomplete: Your profile has required information that is missing. 
• Complete: All required information has been provided. 
• Current: Profile is complete, and attestation is up-to-date. 
• Not Current: The attestation period of 120 days has expired. 

You can always check the status of your credentials by regularly logging into the CAQH ProView portal.

When to Consider Professional Assistance

If you are running into issues or delays in your CAQH profile, or you think you may significantly need help credentialing, here are some circumstances where professional credentialing help would be beneficial: 

• Credentialing for several insurance plans, all at once 
• Complex practice history 
• Persistent CAQH profile issues
• When starting a new practice, and there is a need to expedite 

Many providers think the time they save and the stress they avoid make it worth getting some professional help. 

Conclusion

While the CAQH ProView system has significantly streamlined the credentialing process, it still requires your careful attention to detail and timely follow-up. Typically, your CAQH profile takes 3-10 business days to become active, so you can plan accordingly. 

Remember that CAQH is just one part of the overall credentialing process. Planning for appropriate lead time for both CAQH completion and subsequent payer credentialing ensures you can begin billing insurance credentialing service provider companies with minimal delay, maximizing both your practice revenue and patient access to quality care. 

By preparing well and responding quickly to any verification requests, you can navigate the CAQH process efficiently and focus on what matters most: providing the best service that your patients deserve.